| NPI | 1801227020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101Y00000X Counselor | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2013-12-13 |
| Last Update Date | 2025-09-11 |